POS0558 FLARES OF AUTOIMMUNE RHEUMATIC DISEASE FOLLOWING COVID-19 INFECTION: OBSERVATIONS FROM THE COVAD STUDY
Authors: N. Ravichandran, N. Sandhu, A. Nune, J. Day, P. Sen, E. Nikiphorou, A. L. Tan, M. Joshi, S. Saha, S. Katsuyuki Shinjo, K. Jagtap, V. Agarwal, N. Ziade, T. Velikova, M. Milchert, M. Kuwana, A. Makol, H. Chinoy, V. Agarwal, R. Aggarwal, L. Gupta
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Viral infections can trigger flare of autoimmune rheumatic diseases through upregulation of interferon axis. However, global data on flares of AIRDs following COVID-19 infection is scarce. <h3>Objectives</h3> We aimed to study the prevalence and characteristics of patient-self reported flare of AIRDs following COVID-19 infection as part of the ongoing COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. <h3>Methods</h3> The COVAD study, a cross-sectional patient-self reported electronic survey (157 collaborators, 106 countries) collected data on COVID-19 infection, vaccination and flares among AIRDs. The flares were patient self-reported. AIRDs with flare and without flare were compared. Descriptive stats and binary logistic regression (BLR) (adjusting for age, gender, ethnicity, vaccine type, type of immunosuppression, comorbidities, COVID-19 antibody status, and clinical features during previous COVID-19 infection) were performed. <h3>Results</h3> Of the 15165 respondents, 824 patients with AIRDs who contracted COVID-19 infection were identified. Most of the respondents were Caucasians (53.8%), females (86.5%), and had received the Pfizer-BioNTech vaccine (42.8%). Less than half were on glucocorticoids (41.0%), and methotrexate was the most commonly used immunosuppressant (29.9%). One-third (n=324, 36.9%) of patients with AIRDs reported flare following COVID-19 infection. Women and patients with comorbidities such as asthma, chronic obstructive pulmonary disease, diabetes mellitus, mental health disorders, and those with AID comorbidities had higher odds of flare compared to others (Table 1). Notably, certain features of COVID-19 disease such as joint pain (3.1; 2.0-4.9; &lt;0.001), cough (1.5; 1.04-1.2; 0.030), and abdominal pain (2.5; 1.2-5.0; 0.011) were associated with increased risk of flares in BLR while the vaccine type, number of vaccine doses and autoantibodies against COVID-19 were not predictive. Patients who reported flares had worse PROMIS PF10 physical health scores (p=0.038), pain VAS (p&lt;0.001), and lower mental health scores (p&lt;0.001) compared to those who did not report flares. <h3>Conclusion</h3> One in three patients with AIRDs reported post-COVID-19 disease flares. A past history of asthma, comorbidities and those with certain acute COVID-19 symptoms were at higher risk. <h3>References: NIL</h3> <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Naveen Ravichandran: None declared, Nimrat Sandhu: None declared, Arvind Nune: None declared, Jessica Day Grant/research support from: CSL Limited, Parikshit Sen: None declared, Elena Nikiphorou Speakers bureau: EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly., Consultant of: EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly., Grant/research support from: EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly., Ai Lyn Tan Speakers bureau: ALT has received honoraria for advisory boards and speaking for Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Mrudula Joshi: None declared, Sreoshy Saha: None declared, Samuel Katsuyuki Shinjo: None declared, Kshitij Jagtap: None declared, Vishwesh Agarwal: None declared, Nelly Ziade Speakers bureau: Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre, Grant/research support from: Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre, Tsvetelina Velikova: None declared, Marcin Milchert: None declared, Masataka Kuwana Speakers bureau: Abbvie, Asahi-Kasei, Astellas, AstraZeneca, Boehringer-Ingelheim, Chugai, Corbus, Eisai, GSK, Horizon, Kissei, BML, Mochida, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi. Ashima Makol: None declared, Hector Chinoy Speakers bureau: UCB, and Biogen, Consultant of: Novartis, Eli Lilly, Orphazyme, Astra Zeneca, Grant/research support from: Eli Lilly and UCB, Vikas Agarwal: None declared, Rohit Aggarwal Consultant of: Mallinckrodt; Octapharma; CSL Behring; Bristol Myers-Squibb; EMD Serono; Kezar; Pfizer; AstraZeneca; Alexion; Argenx; Boehringer Ingelheim (BI); Corbus; Janssen; Kyverna; Roivant; Merck; Galapagos; Actigraph; Abbvie; Scipher; Horizontal Therapeutics; Teva; Biogen; Beigene; ANI Pharmaceutical; Nuvig; Capella; CabalettaBio, Grant/research support from: Mallinckrodt; Pfizer; Bristol Myers-Squibb; Q32; EMD Serono; Janssen, Boehringer Ingelheim (BI), Latika Gupta: None declared.